(0641) Enhanced Recovery After Surgery for Transoral Robotic Surgery: A Systematic Review and Evidence-Based Proposal

Introduction: Enhanced Recovery After Surgery (ERAS) protocols aim to standardize patient care with the goals of minimizing surgical complications and improving outcomes. ERAS protocols were successfully implemented in head and neck oncology and found to decrease length of stay (LOS), opioid usage, and transfusion need. Patients undergoing transoral robotic surgery (TORS) are at risk for significant short-term morbidity including hemorrhage and long-term morbidity including swallowing dysfunction. However, existing literature on ERAS protocols specifically for TORS is sparse. We propose an evidence-based TORS ERAS protocol based on a systematic literature review.

Methods: A systematic search of PubMed, Embase, Scopus, and Cochrane was performed in October 2023 in accordance with the PRISMA guidelines. Three reviewers independently screened identified articles by title and abstract and then by full text. Eligible articles were those that focused on ERAS or its components in the context of TORS patients.

Results: Our search yielded 569 articles, with 14 meeting inclusion criteria. Only 1 study consisted of a 5-stage ERAS protocol (pre-admission, preoperative, intraoperative, postoperative, post-discharge) while the others were narrowly focused. Other existing TORS care pathways have been found to decrease pain ratings, opioid usage, time until oral feeding, and LOS. However, these pathways are heterogenous and not entirely evidence based. Using the available literature, we propose an integrated TORS ERAS protocol.

Conclusions: There is only 1 current retrospective study that applied a comprehensive ERAS protocol designed for TORS patients. Prospective studies of evidence-based ERAS protocols are needed to optimize preoperative planning and rehabilitation for this unique patient population.